MPs criticise e-health record progress

The Electronic Patient Record project needs better planning, more consultation and a new timetable, say MPs.

A report from the Commons Health Select Committee on the e-patient record - a key project in the 10-year NHS national programme for IT - highlights a series of problems with the management, security and timescale of the scheme.

The role of Connecting for Health (CfH), the agency responsible for the national IT programme, needs to be increasingly modified. It needs more focus on setting and monitoring national technical standards, if the development of the e-patient record is to be successful, claims the report, published on 13 September 2007.

"Professionally developed datasets and agreed approaches to the structure and content of detailed records are urgently needed for each of the main clinical specialties and for use in a range of different care settings," the report says.

The MPs called on CfH to work with the royal colleges and other professional groups to identify the information standards that will be required within their specialty area to develop consensus-based clinical information standards.

The e-patient record scheme will have two separate systems: a national summary care record (SCR), containing basic information; and a detailed care record (DCR) of more comprehensive information.

After delays, trials of the SCR are under way at a number of sites. However, the committee found it difficult to find out what type of information will be held in the SCR. Furthermore, consent arrangements for creating or adding information have been poorly communicated to patients and clinicians.

Eventually patients will be able to restrict access to sensitive information in "sealed envelopes" and they will be able to access their SCR via the HealthSpace website from home.

The committee wants these features to be improved and implemented as soon as possible, but says that maintaining security will be a "significant challenge", explaining: "Each SCR will be potentially available across the country to a wide range of different users, making operational security especially problematic."

In general, the MPs say that the e-patient record has been hampered by poor communication and a "worrying lack of progress" in implementing local systems.

The DCR, described in the report as a "holy grail" for the national IT programme, should improve safety and efficiency. But its delivery depends on new local IT systems being in place.

Lorenzo, one of the two main patient administration products, is seriously delayed and will not be trialled in the NHS until 2008, which will hold back implementation of the DCR.

"In its original specification documents in 2003, NPfIT established a clear vision for local electronic records systems," the report says. "Four years later, however, the descriptions of the scope and capability of planned DCR systems offered by officials and suppliers were vague and inconsistent.

"Some witnesses suggested that parts of the original vision have been abandoned because of the difficulties of implementing new systems at a local level."

The committee is calling on CfH to publish clear, updated plans for the DCR and on suppliers to publish timetables for completing DCR systems.

Earlier this month, Dr Hamish Meldrum, chair of the British Medical Association, wrote to Health Minister Ben Bradshaw and called for a halt to further implementation of the SCR until an independent review has been completed.

Dr Meldrum said that at a recent BMA meeting, doctors from primary and secondary care expressed their frustration with the programme and want a public enquiry to address problems.

Responding to the report, a Department of Health spokesperson said: "The Health Committee recognises the very real future benefits to patients that will come with the introduction and use of electronic patient records, concluding it is vital for the future of healthcare in England.

"Local NHS organisations are best placed to lead the future implementation of the NHS care records service and that's why, from 1 April this year, we launched the local ownership programme, giving much greater responsibility for controlling and delivering the programme at a local level.

"We will, of course, respond to the committee's full list of conclusions and recommendations in due course."